New caesarean guidelines proposed

Several newspapers have reported that all pregnant women will “get the right to a caesarean”, regardless of whether there is a medical reason for having one. Currently, around one in four UK babies is delivered by caesarean.

The reports are based on new draft guidelines from the National Institute for Health and Clinical Excellence (NICE), the national body that evaluates which treatments should be available for specific conditions. The proposed guidelines are the first major update from NICE on caesarean sections since 2004, and take into account the latest research on the procedure.

Although newspapers focused on caesareans potentially being available to a wider range of women, the draft guidelines cover all aspects of caesarean sections, including planning, timing, the procedure itself and care after a caesarean. The guidelines include a number of new and updated recommendations about all these areas, but the ones relating to who should be offered a caesarean state that:

Requested caesareans

In addition, the draft guidelines set out specific processes to follow if a woman asks for a caesarean:

Cases when a caesarean is recommended

The guidelines also recommend offering a planned caesarean to pregnant women under specific medical circumstances. Caesareans should be offered when a woman has:

No. The draft guidelines do not recommend that every woman should be routinely offered a caesarean. Rather, they state the medical circumstances where one is recommended and where one is not, and discuss the options that are available when a woman has a preference for a caesarean over a vaginal birth.

There are also several scenarios in which the guidelines say that women should not be routinely offered caesarean sections. These include women with:

NICE’s existing caesarean guidance was issued in 2004. These new draft guidelines have take into account the evidence from newer research published since then. NICE’s system for updating its guidance is based on an in-depth, step-by-step process, involving:

Draft guidelines will then be published on the NICE website to allow interested parties to review the recommendations and suggest changes.

No. These guidelines are still undergoing pre-publication checks and may be subject to further changes before they are made official. However, any further changes are likely to be small as the guidelines have already been adapted to incorporate changes suggested in the commenting phase, which occurred in May and June 2011. It is expected that the final, official guidelines will be published in November.